Open Latarjet reduces residual apprehension, redislocation and possibility of dislocation arthropathy compared to arthroscopic Bankart repair despite greater bipolar bone loss in anterior glenohumeral instability

Background

Arthroscopic Bankart repair (ABR) and the open Latarjet (OL) procedure are the most frequently preferred methods in the treatment of anterior glenohumeral instability. The aim of this study was to compare patients who underwent ABR or OL due to anterior glenohumeral instability in terms of functional capacity, glenohumeral bone loss, residual apprehension, redislocation, and dislocation arthropathy.

Methods

A total of 56 patients who underwent ABR or OL due to anterior glenohumeral instability between January 2018 and December 2021 were evaluated retrospectively. There were 32 patients in the ABR group and 24 patients in the OL group. Patients’ demographic characteristics, number of preoperative dislocations, and return-to-work, and follow-up periods were recorded. Glenoid bone loss, Hill–Sachs interval, and Hill–Sachs depth were measured from preoperative computed tomography sections. The American Shoulder and Elbow Surgeons score, the Western Ontario Shoulder Instability Index score, Rowe score, and joint range of motion were calculated. Patients were also asked about residual apprehension, postoperative redislocations, dislocation arthropathy, and surgery satisfaction.

Results

The mean age of the ABR group was 22.5 ± 3.9 years (28 men, 4 women), while that of the OL group was 25.0 ± 4.8 years (22 men, 2 women). The mean number of dislocations was 2.7 ± 1.3 in the ABR and 10.9 ± 5.5 in the OL (P = .001). Higher values of glenoid bone loss (%) (ABR: 6 ± 2; OL: 20 ± 4), Hill–Sachs interval (mm) (ABR: 8 ± 3; OL: 21 ± 3), and Hill–Sachs depth (mm) (ABR: 5 ± 2; OL: 8 ± 2) were measured in the OL (P = .001 for all), reflecting significantly more bone loss. Residual apprehension was detected in 10 patients in the ABR and 2 patients in the OL (P = .007). While 4 patients in the ABR had a history of redislocation, no redislocation occurred in the OL (P = .012). Dislocation arthropathy development was observed in 9 patients in the ABR and 4 patients in the OL (P = .038), according to the modified Samilson and Prieto classification. External rotation in adduction and external rotation in 90° abduction were approximately 5° higher in the OL (P = .011 and P = .016, respectively).

Conclusion

The ABR and OL methods both provide satisfactory outcomes in the treatment of anterior glenohumeral instability with appropriate indications. The OL procedure is preferred for patients with more dislocations and greater bipolar bone loss. Despite greater bipolar bone loss, the OL procedure provides lower rates of residual apprehension, redislocation, and dislocation arthropathy. Additionally, due to the stability it provides, there is less loss in external rotation.